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Background: Adaptation of fat depots to change in fuel availability is critical for metabolic flexibility and cardiometabolic health. The mechanisms responsible for fat depot-specific lipid sensing and shuttling remain elusive. Adipose tissue microvascular endothelial cells (AT-EC) regulates bidirectional fatty acid fluxes depending on fed or fasted state. How AT-EC sense and adapt to metabolic changes according to AT location remains to be established. Methods: We combined transcriptional analysis of native human AT-EC together with in vitro approaches in primary human AT-EC and in vivo and ex vivo studies of mice under fed and fasted conditions. Results: Transcriptional large-scale analysis of human AT-EC isolated from gluteofemoral and abdominal subcutaneous AT revealed that the endothelium exhibits a fat depot–specific signature associated with lipid handling and Notch signaling enrichment. We uncovered a functional link between metabolic status and endothelial DLL4 (delta-like canonical notch ligand 4), which decreases with fasting. DLL4 regulates fatty acid uptake through nontranscriptional modulation of macropinocytosis-dependent long chain fatty acid uptake. Importantly, the changes in DLL4 expression, in response to energy transition state, is impaired under obesogenic conditions, an early alteration coinciding with a defect in systemic fatty acid fluxes adaptation and a resistance to weight loss. Conclusions: DLL4 is a major actor in the adaptive mechanisms of AT-EC to regulate lipid fluxes. It likely contributes to fat depot-dependent metabolism in response to energy transition states. AT-EC alteration with obesity may favor metabolic inflexibility and the development of cardiometabolic disorders.

Human-adipose-tissue-derived mesenchymal stromal cells (AD-MSCs) are currently being tested as autologous-cell-based therapies for use in tissue healing and regeneration. Recent studies have also demonstrated that AD-MSC-derived exosomes contribute to tissue repair and peripheral nerve regeneration. Subcutaneous abdominal adipose tissue (AAT) is divided into two layers: the superficial layer (sAAT) and the deep layer (dAAT). However, it is unclear whether there are particular characteristics of each layer in terms of AD-MSC regenerative potential. Using AD-MSCs purified and characterized from three abdominoplasties, we compared their secretomes and exosome functions to identify which layer may be most suitable as a source for cell therapy. Phenotypical analysis of the AD-MSCs containing stromal vascular fraction did not reveal any difference between the two layers. The AD-MSC secretomes showed a very similar pattern of cytokine content and both layers were able to release exosomes with identical characteristics. However, compared to the secretome, the released exosomes showed better biological properties. Interestingly, dAAT exosomes appeared to be more effective on neuromodulation, whereas neither sAAT nor dAAT-derived exosomes had significant effects on endothelial function. It thus appears that AD-MSC-derived exosomes from the two abdominal adipose tissue layers possess different features for cell therapy.

International audience; BACKGROUND: This study was conducted to assess the impact of abdominoplasty and lower body lift surgery following massive weight loss on both the general quality of life and the sexual life of patients. METHODS: We performed a multicenter prospective study on the quality of life after massive weight loss using three scoring questionnaires: The Short Form 36 questionnaire, the Female Sexual Function Index questionnaire, and the Moorehead-Ardelt Quality of Life Questionnaire. Seventy-two patients who underwent lower body lift and 57 patients who underwent abdominoplasty in three centers with pre and post-operative evaluation were included. RESULTS: The mean age of the patients was 43.2 ± 13.2 years. All categories of the SF36 questionnaire were statistically significant at 6 months, and all categories except health change were significantly improved at 12 months post-operative. Overall, the Moorehead-Ardelt questionnaire showed a higher quality of life in general (1.78 ± 0.92 and 1.64 ± 1.03, at 6 and 12 months respectively) and in all domains (self-esteem, physical activity, social relationships, work performance, and sexual activity). Interestingly, global sexual activity improved at 6 months but not at 12 months. Some domains of sexual life improved at 6 months (desire, arousal, lubrication, satisfaction), but only the desire stayed improved at 12 months. CONCLUSION: Abdominoplasty and lower body lift improve the quality of life of patients after massive weight loss as well as the sexual quality of life. This should be an additional valid reason for promoting reconstructive surgery for massive weight loss patients.

Background Due to the lack of knowledge about parasacral artery perforators, flaps from this region cannot be used with complete confidence in their security and effectiveness. Knowledge of the clusters and perforasome of these perforators could help in the design of more reliable flaps and extend the range of applications. Objectives This study aimed to identify the location, number, and density of perforators, and to subsequently analyze the perfusion flow and linking vessel distribution. Methods Five fresh cadavers were harvested and dissected. For the mapping, after injecting lateral sacral arteries with colored latex, perforators with a diameter of >0.5 cm were examined in 5 sacral regions. All data were collected on the suprafascial plane, with an orthonormal coordinate system placed on iliac crests and median lines. For perforasome analysis, 5 perforators and 3 three sacral flaps were injected with radiopaque dye. A dynamic (4-dimensional) computed tomographic angiography completed the analysis. Results A mean [standard deviation] of 8.4 [1.36] perforators per corpse, with a mean diameter of 0.72 [0.14] mm, were identified. There was a higher density of parasacral perforators close to the median line and 7.6 cm above the iliac crests. This pattern was not a random distribution (P Conclusions Parasacral perforator flaps appear to be a useful procedure in reconstruction and in aesthetic surgery, especially in gluteal augmentation. Their reliability depends on sound anatomic knowledge, with accurate preoperative perforator mapping.

An ideal flap for fingertip injuries should cover a significant loss of substance and avoid joint flexion to prevent later contracture and joint stiffness. In this study, the authors describe a modified homodigital island flap-the homodigital propeller flap-to better meet these requirements.An anatomical model of fingertip loss is used to analyze the advancement achieved without flexion of the finger. Twenty-four fresh-frozen fingers were dissected. Wires were inserted to maintain joints in extension. The skin paddle was similar in location to a homodigital island flap. The neurovascular bundle was dissected without exceeding the proximal interphalangeal joint and was released from the proximal half of the paddle. Then, the homodigital propeller flap was rotated 180 degrees to cover the defect. A mixture of India ink and barium sulfate was injected into the pedicle artery after the release of the proximal half of the flap from the neurovascular pedicle to assess residual flap vascularization. India ink highlights the residual subcutaneous vascularization network of the cutaneous paddle. A radiographic study of the flap was then performed to visualize the subcutaneous vascular network of the cutaneous paddle.The homodigital propeller flap achieved an average cutaneous advancement of 18 mm (range, 15 to 22 mm) and allowed full coverage of cutaneous defects for all fingers while maintaining the proximal interphalangeal joint in strict extension.The homodigital propeller flap is a refinement of the classic homodigital island flap. It allows efficient coverage of fingertip defects because of a large advancement without flexion of the finger, reducing the risk of stiffness.

Lymphedema (LD) is characterized by the accumulation of protein-rich interstitial fluid, lipids and a significant inflammatory cell infiltrate in the limb. It causes a significant morbidity and is a common disabling disease affecting more than 150 million people worldwide, however there is no yet curative treatment. Here, we found that LD tissues from patients exhibit inflamed gene expression profile compared to their normal arm. Lipidomic analysis revealed severe decrease in arachidonic acid-derived lipid mediators generated by the 15-lipoxygenase (15-LO) in lymphedematous arms. Using a mouse model of lymphedema, we reproduced the etiology of the human pathology including the loss of specialized pro-resolving lipid mediators that play essential role in resolution of inflammation. This was associated with a lack of nonlymphoid PPARg-positive regulatory T cells (Treg) recruitment in the injured limb adipose tissue. Importantly, we identified the lymphatic endothelial 15-LO as responsible for the chemoattraction and survival of this Treg subpopulation. These results were confirmed by an aggravation of LD and degradation of the lymphatic network in an original transgenic mouse model in which ALOX15 gene has been selectively deleted in the lymphatic system (ALOX15lecKO). Importantly, this phenotype was rescued by the injection of ALOX15-expressing lentivectors. These results provide evidence that lymphatic 15-LO may represent a novel therapeutic target for LD by serving as a mediator of nonlymphoid Treg cell population invasion into lymphedematous adipose tissue to resolve inflammation.

Introduction The innervation of the digital joints as well as the anatomical relationships of the articular branches is present in this anatomical work to determine the technical feasibility of a selective and efficient denervation of the digital joints. Materials and methods A study of 40 distal interphalangeal (DIP), 40 proximal interphalangeal (PIP), 50 metacarpophalangeal (MCP), 10 interphalangeal (IP) of the thumb, and 10 trapezo-metacarpophalangeal (TMC) joints was performed on ten hands. Under magnification and a proper surgical approach, we collected the course, the source origin, the number of articular nerve branches, and their caliber. Results In total, 118 nerve branches arising from the proper palmar digital nerves were found on 10 DIP of each dissected long finger (n = 40). A total of 226 nerve branches were found on 10 PIPs of each long finger (n = 40), of which 204 branches (90.3%) had a palmar origin. Dorsal innervation was found for the ring and little finger, originating from the dorso-ulnar digital nerve. 212 branches were found on 10 MCP of long fingers (n = 40), including 87 branches of palmar origin (41.1%), 107 branches of dorsal origin (50.4%), and 18 branches of the motor branch of the ulnar nerve (8.5%). 42 articular branches directed to the TMC joint (n = 10) were found. 13 branches (31%) originated from the anterior sensory branch of the radial nerve, 13 branches (31%) originated from the lateral cutaneous nerve of the forearm, 5 branches (12%) originated from the palmar cutaneous branch of the median nerve, and 11 (26%) branches originated from the thenar branch of the median nerve. The involvement of the sensory anterior branch of the radial nerve was always present for the innervation of each TMC. Discussion and conclusion Our research shows that finger joints receive their primary innervation from small branches of the digital nerves with the exception of the MCP joint and the TMC joint. To obtain an efficient and a selective digital denervation for articular pain relief, it is necessary to plan the best surgical approach and it is crucial to recognize the articular nervous branch localization and source.

De-epithelialized flaps have been used in gluteal contouring over the last three decades, but most improve the projection rather than the upper quadrants. The authors provide a detailed description of their method of gluteal augmentation using parasacral perforator-pedicled propeller flaps. This technique achieves a volumetric increase and maximal buttock projection at the midlevel and in the medial half of the buttocks.Between January and December of 2019, a series of 18 patients on whom a lower body lift with a parasacral perforator-pedicled propeller flap had been performed by the senior author (F.B.) were prospectively evaluated. Postoperatively, the satisfaction rate was assessed using a 10-point analog scale (1 = unsatisfied, 10 = very satisfied) by the patient and by two independent surgeons based on photographs taken 1 year after surgery.Eighteen patients underwent this procedure. Their mean age was 32.2 ± 5.6 years (range, 24 to 40 years). The mean flap length was 20.3 cm, their mean width was 10.4 cm, and the mean thickness was 3.4 cm. The authors noted only two minor complications, one seroma and two skin dehiscences that healed without surgery. The rate of satisfaction as assessed by the patients was 8.3 out of 10 (±1.1), and by surgeons, 7.9 and 8.1.This article describes a gluteal autoaugmentation flap technique using parasacral perforator-pedicled propeller flaps to increase projection and volume in the inferomedial gluteal region after lower body lift.Therapeutic, IV.

Background: A few studies have examined the characteristics of severe breast cancer-related lymphedema (BCRL). This study aims at analyzing the factors associated with severe lymphedema (LE) across...

Background Calf shape is an essential aesthetic parameter of the leg, and calf atrophy can lead to complex problems. The functional consequences of calf atrophy are generally moderate. Prefilled silicone gel implants represent the vast majority of currently placed prostheses, but this technique does not ensure optimal adaptation of the implant shape due to loss of volume. Objectives The aim of this study was to describe an innovative procedure for correcting acquired calf atrophy based on 3-dimensional (3D) modeling. Methods The study involved 22 patients treated for calf atrophy caused by illness. Implants were made with solid rubber silicone, and 3D reconstructions were created by computer-aided design based on computed tomography scans. The implants were introduced through a horizontal popliteal incision. Results Forty-one implants were placed. No cases of infection, hematoma, or compartment syndrome were encountered. We experienced 1 case of skin necrosis and 1 case of periprosthetic seroma. In addition, lipofilling was performed in 5 cases. Two patients sought to benefit from a surgical reduction in implant size. Conclusions Our innovative procedure to correct calf atrophy with custom solid rubber silicone implants produces a calf shape that better adapts to volume loss than prefilled silicone gel implants. The material maintains its shape and facilitates retrofitting of the prosthesis. There is no risk of hull formation or breakage, and the life span of the implants is limitless. This 3D computer-aided design approach has optimized our reconstructions. Level of Evidence: 4

The temporal muscle has been an essential tool in maxillo-facial reconstruction for more than a century. Despite many technical advances, depression in the temporal fossa after its use is a constant issue. There are several ways to fill this defect. However, their efficiency has not been proven. Currently, biomaterials (e.g. polymethylmethacrylate [PMMA] and polyethylene [PE]) are the alternative most frequently used and studied. This is the first case report of temporal depression filling with a porcine dermal matrix (Permacol™). A 58-year-old woman underwent limited maxillectomy for squamous cell carcinoma of the upper vestibular mucosa, after which a pure temporalis muscle flap was used for immediate reconstruction. A custom-shaped Permacol™ sheet was used with a PMMA spacer to fill the resulting depression at the temporal fossa. The procedure went smoothly without any complications. The surgeon and the patient are satisfied with the cosmetic result. Permacol™ is a safe and effective tool to fill defects after temporalis muscle flap and is an excellent alternative to other biomaterials currently on the market.

Background The European hidradenitis suppurativa (HS) guidelines recommend a multidisciplinary approach for patients with HS and management of comorbidities. Objective We aimed to describe the organization of a multidisciplinary HS program and characterize the patient population. Methods We conducted a retrospective study of patients with HS undergoing prospectively defined multidisciplinary work-up including examinations by a dermatologist, plastic surgeon, smoking specialist, and nutritionist in our outpatient unit between October 2015 and January 2017. Results The study included 49 patients with a sex ratio of 1:1. A total of 73.4% of patients were smokers, 20.4% were overweight, 48.9% were obese, and 30.6% had symptoms of depression. The mean Sartorius score was 30.4 (±17.6). The outcome of plastic surgery consultation was as follows: 16 patients had operations, 5 were excluded based on medical history, 9 refused surgery, and 16 remained undecided. The refusal rates for consulting with the smoking cessation and nutrition specialists were 55.8% and 69.5%, respectively. Twelve patients received antibiotics, 9 received biologics, 9 underwent medico-surgical treatment, 9 underwent surgery, and 10 were lost to follow-up. The mean visual analogue scale score for satisfaction was 8.3 (±1.6; n = 28). Conclusion An integrated multidisciplinary care model for HS is associated with high patient satisfaction. Adherence to the proposed comorbidity management was higher in female patients and related to empathetic interactions with physicians.

Human adipose-derived stem/stromal cells (hASCs) can differentiate into specialized cell types and thereby contribute to tissue regeneration. As such, hASCs have drawn increasing attention in cell therapy and regenerative medicine, not to mention the ease to isolate them from donors. Culture conditions are critical for expanding hASCs while maintaining optimal therapeutic capabilities. Here, we identified a role for transforming growth factor β1 (TGFβ1) in culture medium in influencing the fate of hASCs during in vitro cell expansion. Human ASCs obtained after expansion in standard culture medium (Standard-hASCs) and in endothelial cell growth medium 2 (EGM2-hASCs) were characterized by high-throughput transcriptional studies, gene set enrichment analysis and functional properties. EGM2-hASCs exhibited enhanced multipotency capabilities and an immature phenotype compared with Standard-hASCs. Moreover, the adipogenic potential of EGM2-hASCs was enhanced, including toward beige adipogenesis, compared with Standard-hASCs. In these conditions, TGFβ1 acts as a critical factor affecting the immaturity and multipotency of Standard-hASCs, as suggested by small mother of decapentaplegic homolog 3 (SMAD3) nuclear localization and phosphorylation in Standard-hASCs vs EGM2-hASCs. Finally, the typical priming of Standard-hASCs into osteoblast, chondroblast, and vascular smooth muscle cell (VSMC) lineages was counteracted by pharmacological inhibition of the TGFβ1 receptor, which allowed retention of SMAD3 into the cytoplasm and a decrease in expression of osteoblast and VSMC lineage markers. Overall, the TGFβ1 pathway appears critical in influencing the commitment of hASCs toward osteoblast, chondroblast, and VSMC lineages, thus reducing their adipogenic potential. These effects can be counteracted by using EGM2 culture medium or chemical inhibition of the TGFβ1 pathway.

Introduction: Autologous fat transfer (AFT) is widely used to improve results of breast reconstructive surgery. But its safety has been controversial. Heterogeneous studies, in which AFT has been used in different clinic situations (breast augmentation, after prophylactic surgery, with radical or partial breast cancer surgery) led the High Autority of Health in France in 2015 to publish precautionary measures for its use after radical mastectomy. Our objective is to evaluate the oncologic safety of AFT in a homogeneous population of patients who underwent a total mastectomy with immediate reconstruction for breast cancer. Methods: Our unicentric retrospective cohort study concerns a consecutive cases serie of total mastectomy with immediate reconstruction for breast cancer between 2007 and 2015 at the Institut Universitaire du Cancer de Toulouse. An analysis in landmark has been used to evaluate the effect of AFT on the living patients without events at 24 months. Results: 628 cases of mastectomies have been included; and 550 cases were analyzed with the landmark method. The majority (84,5%) got an implant reconstruction. 136 (24,7%) underwent at least 1 fat graft transfer. 62,5 % of these patients had only one AFT. The two groups of patients, with and without AFT, were comparable for disease stage with respectively: Tumor stage: Tis 26,5% vs 34,3%; T1 60,3% vs 50,4%; T2 11,8% vs 13,1% (p = 0,2026); nodal involvement 22,1% vs 23,5 %; histologic luminal sub type (RH+/her2 -) 77,3% vs 74,3% (p = 0,5612). They were also similar for adjuvant treatment with respectively: chemotherapy for 27,2 % vs 30,7 % (p = 0,4427), radiotherapy for 30,9% vs 31,9% (p=0,8275), hormonotherapy 60,7% vs 54,1% (p=0,1778). Median follow up was 55,2 months (95% IC [52.9;57.7]). Disease free survival (DFS) was 90,4%. There was no difference for DFS between the 2 groups: 92,32% [88.75;94.79] for the group without AFT and 90,91 % [81.01;95.78] for the AFT group (p = 0,9569). In subgroups analysis, for the patients which had undergone a AFT, there was no difference of DFS for the patients younger than 50 years old 89,82% vs 86,09 %; (p = 0,7079), the ones with high grade intra ductal carcinoma 92,27% vs 89,83%; p = 0,6189). Only patients with nodal involvement who underwent a fat graft transfer within 24 months, had a lower DFS: 69,15% than the patients without nodal involvement 92,46% (p=0,0351). Conclusion: Autologous fat transfer used within the 24 months after total mastectomy for breast cancer and immediate reconstruction does not change disease free survival. Complementary analysis must be done in case of nodal involvement. Citation Format: Donia Omalek, Leonor Chaltiel, Charlotte Vaysse, Dimitri Gangloff, Thomas Meresse, Benoit Chaput, Eva Jouve, Gabrielle Selmes. Evaluation of the oncologic safety of autologous fat transfer after a total mastectomy and immediate reconstruction for breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-14-01.

Resume Le pectus excavatum affecte environ une personne sur 500 : c’est la malformation du thorax la plus frequente. Plusieurs techniques chirurgicales ou medicales ont ete proposees. Certaines peuvent entrainer des complications ou des resultats insuffisants. La chirurgie secondaire du pectus excavatum par implants profonds sur mesure 3D est une solution elegante et efficace. Elle permet d’obtenir le bon resultat esthetique attendu par les patients en l’absence de contexte fonctionnel respiratoire ou cardiovasculaire.

Flap reconstruction techniques are increasingly desired by French's patients and it represents almost half of breast reconstruction indications in 2017. The main reasons of this statistics are the growing concerns of the patients with breast implant of developing BIA-ALCL, as well as their desire of having a more natural reconstruction results without having any foreign bodies. The multiplication of autologous reconstruction techniques, especially microsurgical techniques which has been popularized in the recent years, makes possible to propose a reconstruction to the majority of patients without an implant. This type of reconstructions is associated with a significant number of complications; thus, a proper selection of patient should be done and a good knowledge of the surgical technique by the surgeon to reduce the complication. Our proposed study is divided into two main parts, the complications of the flap and the complications at the donor site. Based on the experience of our plastic surgery department in immediate and delayed breast reconstruction, the objective of this article is to describe and to analyze the possible complications of breast reconstruction by a flap and their surgical management in intra and post operatively. Our goal is to provide an algorithm for our young colleagues in order to obtain better understanding of this type of interventions difficulties and to provide an appropriate care in the event of complication, also to provide optimal care to the patients who wish to undergo autologous flap reconstructions.

Summary Ectodermic dysplasia corresponds to genetic pathologies characterized by two or more defects that involved ectodermal-derived structures. Breast anomalies in female patients were uncommon. Just a few articles in the literature retrieved this association. The main anomalies concerning breast region were amastia and areolar complex malformation. Two types of reconstruction have been already studied: implants with or without tissue preexpansion, and autologous flap like latissimus dorsi or DIEP. We described in this article a series of three female patients issue from the same family. They presented various type of breast malformation with other defects characteristics of ectodermic dysplasia. They all benefit of a bilateral breast reconstruction by implants on a one-staged reconstruction. Patients and surgeon were satisfied of the reconstruction. This case series demonstrate that reconstruction by implants without tissue preexpansion was a good choice in this pathology.

Digital neurovascular bundle defects are often encountered during crush or avulsion injuries and require complex reconstruction. Use of an arterialized nerve graft (neurovascular graft) serving both as an interpositional arterial conduit and as a nerve graft could be a reconstructive option in these cases. In this anatomical study, the authors aimed to describe a neurovascular graft of the posterior interosseous nerve and a branch of the anterior interosseous artery for neurovascular bundle reconstruction of the fingers.Eighteen forearms were injected with red latex in order to collect the anatomical characteristics of the posterior interosseous nerve and the artery running near it.In all cases, the posterior interosseous nerve was followed by a branch of the anterior interosseous artery: the distal dorsal branch of the anterior interosseous nerve. The origin of this artery was proximal to the radiocarpal joint, at an average of 56.5 ± 11.1 mm. The proximal and distal diameters of the branch of the anterior interosseous artery were 1.6 ± 0.2 and 1.1 ± 0.2 mm, respectively. The proximal and distal diameters of the posterior interosseous nerve were 1.2 ± 0.3 mm and 1.1 ± 0.3 mm, respectively.These results show that a potential free neurovascular graft using the posterior interosseous nerve as nerve graft and the anterior interosseous artery as an arterial bypass to reconstruct both the nerve and arterial tree of the finger could be a useful approach. The authors speculate that this graft could be used to reconstruct the neurovascular bundle of amputated or devascularized digits.

International audience; Background The aim of this study was to assess the impact of medial thighplasty following massive weight loss on the quality of life of patients and on their sexual life. Methods We performed a multicentric, prospective study on the quality of life after massive weight loss using the Short-Form 36 questionnaire, the Female Sexual Function Index questionnaire, and the Moorehead-Ardelt Quality of life questionnaire. Forty-nine patients who underwent medial thighplasty were included in three centers and evaluation was made pre- and post-operatively. Results The mean age of the patients was 44 +/- 12.5 years. The average pre-medial thighplasty body mass index was 27 +/- 3.8 kg/m(2). All the categories of the SF36 questionnaire scored higher after surgery apart from "health change" but only the "role limitations due to emotional problems" category was significantly improved (p= 0.0081). Similarly, the MooreheadArdelt questionnaire showed a positive impact of the surgery on the quality of life in general (mean total score 1.04 +/- 1.37) and on self- esteem, physical activity, social relationships, and work performance. Interestingly, sexual activity was not improved by the surgery and this result is in line with the FSFI, which showed no effect of medial thighplasty on sexual life. Conclusions Medial thighplasty improves the quality of life of patients after massive weight loss but does not seem to modify the sexual quality of life. These results clearly indicate that this surgery should be widely offered to patients seeking reconstruction of massive weight sequelae.

Limb-sparing surgery combined with radiation has become the standard treatment for soft tissue sarcomas. Despite the many advantages of reconstruction procedures, such as muscle-sparing flap and local reconstruction, the use of pedicled perforator flaps remains non-consensual due to doubts about their reliability when associated with radiotherapy. This study evaluated their surgical reliability in reconstructive surgery for limb and trunk soft tissue sarcomas, in terms of healing time, wound disorders, and postoperative complications, regardless of radiation timing.We realized a retrospective, observational, bi-center study (Cancer University Institute of Toulouse Oncopole, France and Bergonié Institute Bordeaux, France) and describes pedicled perforator flaps performed between January 2015 and January 2021.A total of 74 flaps were included. The median age of the population was 70-year-old. The group consisted of 68.8% (n = 51/74) propeller flaps. We found a partial necrosis rate of 28.4% (n = 21/74), scar disunion of 48.6% (n = 36/74), local infection of 10.8% (n = 8/74), and venous congestion of 13.5% (n = 10/74). Only 16.2% (n = 12/74) required secondary surgical repair to a local complication. The average length of stay was 7.3 days [1.0-25.0]. The mean operating time of our flaps was 133.4 min [38.0-280.0].Pedicled perforator flaps are a surgical technique that can be used in reconstructive surgery for limb and trunk soft tissue sarcomas in adults, regardless of radiation timing. However, these flaps carry a high rate of postoperative complications so they should be reserved for expert surgeons in referral centers.

Fibro adipogenic progenitors (FAPs) play a crucial role in skeletal muscle regeneration, as they generate a favorable niche that allows satellite cells to perform efficient muscle regeneration. After muscle injury, FAP content increases rapidly within the injured muscle, the origin of which has been attributed to their proliferation. Recently, single-cell RNAseq approaches have revealed phenotype and functional heterogeneity in FAPs. Here we report that FAP-like cells residing in subcutaneous adipose tissue (ScAT), the adipose stromal cells (ASCs), are rapidly released from ScAT in response to muscle injury. In parallel, we show in healthy humans that exercise-induced muscle stress response triggers the migration of human native ASCs. Additionally, we find that released ASCs infiltrate the damaged muscle, via a platelet dependent mechanism and that blocking ASC infiltration impairs muscle regeneration. Collectively, our data reveal that ScAT is an unsuspected physiological reservoir of regenerative cells that support skeletal muscle regeneration.

L’eccesso cutaneo che interessa l’interno della coscia, legato all’invecchiamento della pelle o, il piu delle volte, secondario alla perdita di peso, e un problema che ogni chirurgo plastico deve affrontare nella sua pratica clinica quotidiana. La gestione chirurgica comporta il lifting della faccia interna della coscia, comunemente chiamato “cruroplastica”. Questo intervento, che e stato praticato per cinque decenni, ha beneficiato di numerosi sviluppi tecnici che gli hanno permesso di prosperare. L’obesita e una vera e propria piaga che colpisce molti paesi sviluppati, con un impatto socioeconomico significativo. Le tecniche di chirurgia bariatrica, in pieno sviluppo negli ultimi anni, forniscono una massiccia perdita di peso sotto controllo medico e consentono una chirurgia della silhouette, una volta che il peso si e stabilizzato. Questa chirurgia postbariatrica fa ormai parte dell’arsenale terapeutico indispensabile per il chirurgo plastico per soddisfare al meglio le esigenze dei pazienti. Gli obiettivi di questo articolo sono esporre le tecniche moderne di lifting della faccia interna della coscia, specificare i risultati attesi con i loro limiti ed evidenziare le varie complicanze con la loro gestione.

El pectus excavatum es la malformacion toracica congenita mas frecuente. Se han descrito diferentes tecnicas quirurgicas, pero debido a la ausencia de repercusion funcional del pectus excavatum, en la experiencia de los autores de este articulo, la opcion quirurgica de eleccion es la correccion mediante la colocacion de una protesis en posicion profunda. Se obtiene un prototipo en resina de la protesis a partir de imagenes virtuales de sintesis procedentes de cortes tomograficos (diseno asistido por ordenador). A traves de una via de acceso preesternal media, de 5-7 cm de longitud, se diseca la celda para la protesis en proximal, en posicion retropectoral, colocando el implante por debajo de las fibras caudales del pectoral mayor y entre la vaina anterior y el musculo recto abdominal en distal. Al contrario que las tecnicas agresivas de cirugia toracica y pediatrica, se trata de una tecnica simple, muy precisa, independientemente de la profundidad y de la asimetria, con una mortalidad nula y una baja morbilidad. La tasa de satisfaccion de los pacientes es casi del 90%. La complicacion mas frecuente es el seroma, cuyo tratamiento es sencillo y esta bien codificado. La tecnica de reconstruccion mediante implante a medida se puede considerar como una tecnica de referencia, que permite responder a la demanda morfologica real de los pacientes cuando no existen problemas funcionales.

La pelle in eccesso delle braccia, legata all’invecchiamento cutaneo o, il piu delle volte, secondaria alla massiccia perdita di peso, e un problema che deve affrontare ogni chirurgo plastico nella sua pratica clinica quotidiana. L’obesita colpisce oltre il 13% della popolazione mondiale. Pertanto, parallelamente allo sviluppo della chirurgia bariatrica, la chirurgia morfologica volta a correggere i difetti residui della massiccia perdita di peso e in aumento da circa una decina d’anni. Inoltre, l’invecchiamento causa un rilassamento tegumentario, che puo essere disarmonico e che diventa una ragione frequente di consulto medico. Questo eccesso cutaneo o cutaneoadiposo puo essere corretto mediante brachioplastica, chiamata anche dermolipectomia brachiale o, comunemente, “lifting delle braccia”. Lo scopo di questo articolo e di descrivere le diverse forme cliniche insieme alle classificazioni chirurgiche. Di seguito, vengono esposte le tecniche chirurgiche e le potenziali complicanze di queste procedure.